Oral Manifestations and Periodontal Health in Children and Adolescents with Inflammatory Bowel Disease: Current Evidence and Clinical Implications

Background: Pediatric inflammatory bowel disease (PIBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated disorder with a steadily increasing global incidence. Oral manifestations, from nonspecific findings such as recurrent aphthous ulceration to disease-specific features such as cobblestoning, may precede gastrointestinal symptoms, although their diagnostic utility for early IBD detection remains unestablished. Increasing evidence also suggests an association between PIBD and impaired periodontal health. This review aimed to evaluate the current evidence regarding oral manifestations and periodontal health in children and adolescents with inflammatory bowel disease and to assess their potential clinical implications. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Observational studies assessing oral manifestations and periodontal outcomes in patients aged 0–18 years with a confirmed diagnosis of inflammatory bowel disease were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Results: Thirty-one observational studies were included, comprising 5249 reported participants; after accounting for overlapping populations and applying the predefined eligibility criteria, 4609 participants contributed to the analytical dataset. Crohn’s disease exhibited the highest reported prevalence and broadest spectrum of oral manifestations, particularly mucogingivitis, recurrent aphthous ulcers, orofacial granulomatosis, lip swelling, cobblestoning of the oral mucosa, and mucosal tags. Oral manifestations associated with ulcerative colitis were less frequent and generally nonspecific. Several studies reported oral manifestations preceding the diagnosis of intestinal disease, although their utility as early clinical indicators remains uncertain. Across heterogeneous study populations, children and adolescents with inflammatory bowel disease were generally reported to have poorer periodontal parameters than healthy controls, including greater gingival inflammation, bleeding, and periodontal treatment needs, although findings were not uniformly consistent across studies. Some studies reported improvement in oral and periodontal findings following control of intestinal inflammation, whereas associations with disease activity indices and inflammatory biomarkers remained inconsistent. Conclusions: Oral and periodontal manifestations have been frequently reported in pediatric inflammatory bowel disease, particularly in Crohn’s disease, and may provide clinical clues to underlying intestinal pathology. Routine oral and periodontal assessment may be valuable as part of multidisciplinary care for pediatric patients with IBD. Further studies are needed to clarify the potential role of these findings as biomarkers for early diagnosis and disease monitoring.